Application for Change of Permanent Plan (Medical)

ICR 201012-2900-005

OMB: 2900-0179

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
28423 Unchanged
ICR Details
2900-0179 201012-2900-005
Historical Active 200712-2900-025
VA 2900-0179
Application for Change of Permanent Plan (Medical)
Extension without change of a currently approved collection   No
Regular
Approved without change 06/27/2011
Retrieve Notice of Action (NOA) 04/19/2011
  Inventory as of this Action Requested Previously Approved
06/30/2014 36 Months From Approved 06/30/2011
28 0 28
14 0 14
0 0 0

This form is designed for use by the insured to establish eligibility to change insurance plans. The information is authorized by law, 38 CFR Section 6.48 and 8.36.

US Code: 38 USC 1906 Name of Law: Policy provisions
   US Code: 38 USC 1944 Name of Law: Policy provisions
  
None

Not associated with rulemaking

  76 FR 10 01/14/2011
76 FR 58 03/25/2011
No

1
IC Title Form No. Form Name
Application for Change of Permanent Plan (Medical) VA Form 29-1549 Application for Change of Permanent Plan (Medical)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 28 28 0 0 0 0
Annual Time Burden (Hours) 14 14 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$207
No
No
No
No
No
Uncollected
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/19/2011


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